[Clinical utility of the 64-card version of the Wisconsin Card Sorting Test in patients with traumatic brain injury]. / Utilidad clinica de la versión de 64 cartas del test de clasificación de cartas de Wisconsin en pacientes que han sufrido un traumatismo craneoencefálico.

AIMS: To analyze the validity of the single deck 64-card Wisconsin Card Sorting Test (WCST-64) compared to the standard version (WCST-128), and to study the sensibility of both versions to identify changes over time in patients with traumatic brain injury (TBI). PATIENTS AND METHODS: The WCST was administered twice across a 6-month period to a sample of 50 patients with TBI. Pearson correlation coefficients were calculated to examine bivariate associations between WCST-128 scores and the corresponding WCST-64 scores at inclusion and at follow-up. Agreement in classification of impairment (z = -1) or normal performance was calculated for the two tests (kappa). Significant change over time was also analyzed for both versions of the test (paired-samples t test). RESULTS: The results revealed positive and significant correlations between both measures as well as a significant agreement in the classification of patients as having deficits or not. Moreover, the WCST-128 and the WCST-64 showed similar ability to identify changes over time. CONCLUSIONS: Our findings showed strong associations between scores derived from the two test and support the comparability of both versions when analyzing cross-sectional or longitudinal data. The findings support the use of the WCST-64 in evaluations of executive deficits of patients with moderate and severe TBI.

[When do patients with traumatic brain injury lose verbal information? Implications for cognitive rehabilitation]. / Cuándo pierden la información verbal los pacientes con daño cerebral postraumático? Implicaciones para la rehabilitación cognitiva.

AIM: Longitudinal study of verbal learning and memory processes after traumatic brain injury (TBI). PATIENTS AND METHODS: Twenty-six patients who had sustained a moderate-severe TBI were assessed with a Spanish version of the California Verbal Learning Test at the time of admission and 6-months after inclusion in a multidisciplinary rehabilitation program that comprised rehabilitation strategies for memory impairments. Global memory indexes were determined, including retroactive interference, proactive interference and recall indexes controlled for level of verbal acquisition. Memory change over time was correlated to demographic and clinical relevant variables, including the level of patients' self-awareness. RESULTS: More than 75% of our patients presented learning, immediate memory and delayed memory deficits at baseline, with an important effect of retroactive interference (69%). At 6-month follow-up, 34.6% showed learning difficulties, 46.2% immediate memory deficits, and 53% delayed memory problems, with 34.6% of the patients showing retroactive interference. Chronicity, level of self-awareness and premorbid intelligence correlated to the degree of memory change over time. CONCLUSIONS: Prominent verbal memory problems developed, not only during the first months after TBI but also over time are mostly due to impaired consolidation related to an intense retroactive interference. These data should be considered when developing memory rehabilitation strategies.

Utilidad clínica de la versión de 64 cartas del test de clasificación de cartas de Wisconsin en pacientes que han sufrido un traumatismo craneoencefálico / Clinical utility of the 64-card version of the Wisconsin card sorting test in patients with traumatic brain injury

Estudiar la relación entre las versiones estandarizada (WCST-128) y abreviada (WCST-64) del test declasificación de cartas de Wisconsin, con el fin de valorar su utilidad comparable y establecer la sensibilidad de ambas versiones para detectar cambios a lo largo del tiempo en una muestra clínica de pacientes con el diagnóstico de traumatismo craneoencefálico (TCE). Pacientes y métodos. La muestra estuvo compuesta por 50 pacientes con TCE, que fueron evaluadosen dos ocasiones, con un intervalo de aproximadamente seis meses. Se correlacionaron las puntuaciones entre ambas versiones tanto al inicio como al final (Pearson), así como su capacidad para detectar alteraciones (kappa) y cambios a lo largo del tiempo (t de Student para muestras pareadas). Resultados. Los resultados mostraron correlaciones positivas estadísticamentesignificativas entre las puntuaciones directas de la mayoría de los índices de ambas versiones, así como un significativo acuerdo en la clasificación de los pacientes en función de la presencia (z = –1) o no de déficit, tanto en la primera como en lasegunda valoración. Además, ambas versiones mostraron capacidad similar para detectar cambios a lo largo del tiempo. Conclusiones. Nuestros resultados demuestran la utilidad comparable entre el WCST-128 y el WCST-64, tanto transversal como longitudinalmente, de forma que ambas versiones se pueden considerar igualmente idóneas para la detección de déficit en funciones ejecutivas en pacientes que han sufrido un TCE. La versión abreviada, sin embargo, sería más apropiada cuando sequiera reducir el efecto fatiga teniendo la garantía de una detección del déficit adecuada

To analyze the validity of the single deck 64-card Wisconsin Card Sorting Test (WCST-64) compared to thestandard version (WCST-128), and to study the sensibility of both versions to identify changes over time in patients with traumatic brain injury (TBI). Patients and methods. The WCST was administered twice across a 6-month period to a sample of 50 patients with TBI. Pearson correlation coefficients were calculated to examine bivariate associations between WCST-128scores and the corresponding WCST-64 scores at inclusion and at follow-up. Agreement in classification of impairment (z = –1) or normal performance was calculated for the two tests (kappa). Significant change over time was also analyzed for both versions of the test (paired-samples t test). Results. The results revealed positive and significant correlations betweenboth measures as well as a significant agreement in the classification of patients as having deficits or not. Moreover, the WCST-128 and the WCST-64 showed similar ability to identify changes over time. Conclusions. Our findings showed strong associations between scores derived from the two test and support the comparability of both versions when analyzing crosssectionalor longitudinal data. The findings support the use of the WCST-64 in evaluations of executive deficits of patients with moderate and severe TBI

¿Cuándo pierden la información verbal los pacientes con daño cerebral postraumático? Implicaciones para la rehabilitación cognitiva / When do patients with traumatic brain injury lose verbal information? Implications for cognitive rehabilitation

Estudio longitudinal sobre los procesos de aprendizaje y memoria verbal tras un traumatismo craneoencefálico(TCE). Pacientes y métodos. Se evaluaron 26 pacientes que habían sufrido un TCE con el test de aprendizaje verbal complutense de forma subaguda (1-5 meses después del TCE) y tras seis meses de rehabilitación multidisciplinar. Se determinaronlos coeficientes globales de la escala, incluyendo interferencia retro y proactiva y los índices de evocación controlados según el grado de aprendizaje previo. Se determinaron los índices de cambio a lo largo del proceso de seguimiento (puntuaciónglobal final de cada variable menos puntuación inicial) y se correlacionaron (Spearman) con las variables demográficas y clínicas con reconocido valor pronóstico, incluyendo el grado de conciencia de enfermedad. Resultados. Más de las tres cuartas partes de nuestros pacientes presentaban alteraciones de aprendizaje, de memoria inmediata y de memoria tardía,con un importante efecto de interferencia retroactiva en 18 (69%) pacientes. A los seis meses, un 34,6% presentaba alteraciones de aprendizaje, un 46,2% de memoria inmediata, un 53% de memoria tardía, y el efecto interferencial se mantenía en un 34,6%. La cronicidad, el grado de conciencia de los déficit y la capacidad intelectual premórbida correlacionaron con los índices de cambio. Conclusiones. La mayoría de los problemas de evocación que aparecen tanto de forma subaguda como crónica tras un TCE se debe a problemas de consolidación en relación con un potente efecto de interferencia retroactiva. Estos datos deben considerarse a la hora de diseñar estrategias de intervención terapéutica, dado su beneficio

Longitudinal study of verbal learning and memory processes after traumatic brain injury (TBI). Patients and methods. Twenty-six patients who had sustained a moderate-severe TBI were assessed with a Spanish version of the California Verbal Learning Test at the time of admission and 6-months after inclusion in a multidisciplinary rehabilitation program thatcomprised rehabilitation strategies for memory impairments. Global memory indexes were determined, including retroactive interference, proactive interference and recall indexes controlled for level of verbal acquisition. Memory change over timewas correlated to demographic and clinical relevant variables, including the level of patients’ self-awareness. Results. More than 75% of our patients presented learning, immediate memory and delayed memory deficits at baseline, with an importanteffect of retroactive interference (69%). At 6-month follow-up, 34.6% showed learning difficulties, 46.2% immediate memory deficits, and 53% delayed memory problems, with 34.6% of the patients showing retroactive interference. Chronicity, level ofself-awareness and premorbid intelligence correlated to the degree of memory change over time. Conclusions. Prominent verbal memory problems developed, not only during the first months after TBI but also over time are mostly due to impaired consolidation related to an intense retroactive interference. These data should be considered when developing memory rehabilitation strategies

[The 'awareness climbing': an educational board game for improving self-awareness following acquired brain injury]. / 'Escalada de la conciencia': un instrumento para mejorar la conciencia de enfermedad en pacientes con dano cerebral adquirido.

AIM: To establish the effectiveness of an educational board game for improving self-awareness following acquired brain injury. PATIENTS AND METHODS: The 'awareness climbing' is a board game format intervention for improving awareness of patients with acquired brain injury (ABI) and for facilitating the use of anticipatory and compensatory strategies. 17 patients with ABI (traumatic brain injury, 10; stroke, 5; others, 2) were included in a self-awareness rehabilitation program using the 'awareness climbing'. Self-awareness was assessed with the Self-Awareness of Deficit Interview (SADI) before and after game intervention. According to the SADI self-awareness consists of three-interdependent levels: intellectual awareness (impairments), emergent awareness (disability) and anticipatory awareness, which involve the client predicting when impairments will affect his or her performance. RESULTS: Initially five patients showed impaired intellectual awareness, four patients had difficulties on emergent awareness and nine patients showed deficits on anticipatory awareness. Intellectual awareness improved in 10 patients, while six patients experienced improvements in emergent awareness over the intervention period. The most striking change was an improvement in 70% of the sample (n = 11) in anticipatory awareness after game sessions. CONCLUSION: According to SADI scores we suggest that the 'awareness climbing' may be a useful tool for improving self-awareness after acquired brain injury.

‘Escalada de la conciencia’: un instrumento para mejorar la conciencia de enfermedad en pacientes con daño cerebral adquirido / The "awareness climbing". an educational board game for improving self-awareness following acquired brain injury

Objetivo. Determinar la eficacia de una herramienta lúdico-terapéutica (‘escalada de la conciencia’) como método para rehabilitar la conciencia de enfermedad en sujetos con daño cerebral adquirido (DCA). Pacientes y métodos. La ‘escalada de la conciencia’ es una herramienta lúdica que facilita la adquisición de conocimientos necesarios para la adecuada percepción de las deficiencias y pone en práctica estrategias de afrontamiento y compensación de las diferentes limitaciones funcionales generadas tras un DCA. Se incluyó a 17 pacientes con DCA (traumatismo craneoencefálico, 10; ictus, 5; otros, 2). El grado de conciencia de los déficit y de sus implicaciones funcionales se valoró mediante la Self-Awareness of Deficit Interview (SADI) antes y después de un programa de intervención que incluía esta herramienta. La entrevista SADI mide tres aspectos de la conciencia: autoconciencia de los déficit, conciencia de las consecuencias funcionales y capacidad de establecer metas realistas. Resultados. Inicialmente, cinco pacientes presentaban problemas de autopercepción de sus déficit; cuatro, problemas de autopercepción de su discapacidad, y nueve tenían dificultades para establecer metas realistas de futuro. A lo largo del proceso de seguimiento, la percepción de los déficit mejoró en diez pacientes, y la percepción de las dificultades generadas por tales déficit, en seis. El cambio más significativo fue que, tras las sesiones de entrenamiento, el 70% de los sujetos (n = 11) aprendió a establecer metas realistas en función de los problemas generados por su patología. Conclusión. Los resultados obtenidos en la entrevista SADI convierten la ‘escalada de la conciencia’ en un instrumento válido y útil en el proceso rehabilitador de la conciencia de enfermedad en pacientes con DCA

Aim. To establish the effectiveness of an educational board game for improving self-awareness following acquired brain injury. Patients and methods. The ‘awareness climbing’ is a board game format intervention for improving awareness of patients with acquired brain injury (ABI) and for facilitating the use of anticipatory and compensatory strategies. 17 patients with ABI (traumatic brain injury, 10; stroke, 5; others, 2) were included in a self-awareness rehabilitation program using the ‘awareness climbing’. Self-awareness was assessed with the Self-Awareness of Deficit Interview (SADI) before and after game intervention. According to the SADI self-awareness consists of three-interdependent levels: intellectual awareness (impairments), emergent awareness (disability) and anticipatory awareness, which involve the client predicting when impairments will affect his or her performance. Results. Initially five patients showed impaired intellectual awareness, four patients had difficulties on emergent awareness and nine patients showed deficits on anticipatory awareness. Intellectual awareness improved in 10 patients, while six patients experienced improvements in emergent awareness over the intervention period. The most striking change was an improvement in 70% of the sample (n = 11) in anticipatory awareness after game sessions. Conclusion. According to SADI scores we suggest that the ‘awareness climbing’ may be a useful tool for improving self-awareness after acquired brain injury